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GRAFTJACKET

Maryland rates for HCPCS Q4107

GRAFTJACKET, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $85$850%50%$85Professionalmedian $85 · 10th–90th $81$1260%50%10th90th$85$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$85.11
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$138.04
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$162.18
Typical High
$204.17